Nokea
The nurse is caring for a patient with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment?
- A. Blood pressure
- B. Phosphate level
- C. Neurological status
- D. Creatinine clearance
Correct Answer: B
Rationale: Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
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The nurse is caring for a patient with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan of care?
- A. Place the patient on bed rest.
- B. Start continuous pulse oximetry.
- C. Discontinue the urinary catheter.
- D. Restrict the patient's oral protein intake.
Correct Answer: A
Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The urinary catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
The nurse is caring for a patient who requires vascular access for hemodialysis and asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. Which of the following information should the nurse explain is an advantage of the fistula?
- A. Is much less likely to clot
- B. Increases patient mobility.
- C. Accommodates larger needles.
- D. Can be used sooner after surgery.
Correct Answer: A
Rationale: AV fistulas are much less likely to clot than grafts although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.
The nurse is preparing to administer calcium carbonate to a patient with chronic kidney disease (CKD) Which of the following laboratory results should the nurse check prior to administration?
- A. Creatinine
- B. Potassium
- C. Total cholesterol
- D. Serum phosphate
Correct Answer: D
Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
The nurse is caring for a patient who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in patient teaching?
- A. Increased calories are needed because glucose is lost during hemodialysis.
- B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
- C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
- D. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
Correct Answer: C
Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, there is less protein lost, therefore more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which of the following actions should the nurse take first?
- A. Document the QRS interval.
- B. Notify the patient's health care provider.
- C. Look at the patient's current blood urea nitrogen (BUN) and creatinine levels.
- D. Check the patient's most recent blood potassium level.
Correct Answer: D
Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.